Provider Demographics
NPI:1013200542
Name:MICHAEL O. STUTTS O.D.LLC
Entity Type:Organization
Organization Name:MICHAEL O. STUTTS O.D.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETIRST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:STUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-314-4424
Mailing Address - Street 1:401 COX BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-4059
Mailing Address - Country:US
Mailing Address - Phone:256-314-4424
Mailing Address - Fax:256-314-4535
Practice Address - Street 1:401 COX BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-4059
Practice Address - Country:US
Practice Address - Phone:256-314-4424
Practice Address - Fax:256-314-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS654TA084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL127255Medicaid